高齢口腔がん患者の術前評価と術後嚥下障害の関連—後ろ向きケースコントロール研究

Association between preoperative assessment and postoperative dysphagia in elderly oral cancer patients:A retrospective case-control study

　【緒言】がん治療前の高齢者に対する脆弱性評価が推奨されている．本研究では高齢者機能評価を活用した術前評価と術後嚥下障害の関連を明らかにする．【対象と方法】当院口腔腫瘍外科で2019年7月〜2023年6月に悪性腫瘍の手術治療を終えた65歳以上の症例を対象とした．治療終了時のDysphagia Severity Scaleが5以下の症例を嚥下障害あり群に，6以上の症例を嚥下障害なし群に分類した．口腔がん手術後の嚥下障害の因子を共変量として傾向スコアマッチングを行い，手術前の嚥下機能と口腔器官機能および高齢者機能評価の結果を群間比較した．【結果】口腔器官機能，Geriatric 8，併存症，認知機能，栄養，転倒が嚥下障害あり群で不良だった．嚥下機能，うつは嚥下障害なし群が不良であった．【結論】嚥下障害あり群はサルコペニアに関連する評価が不良で,手術前のサルコペニア評価の有用性が示唆された．

　Assessment of vulnerability is recommended for elderly patients prior to their cancer treatment. This study aims to clarify the association between preoperative geriatric assessment and postoperative dysphagia. Subjects of this study were 65 years or older patients who had completed surgical treatment for malignant tumors at the Department of Oral Oncology in our hospital between July 2019 and June 2023. At the end of treatment, patients who scored 5 or less on the Dysphagia Severity Scale were classified into the group with dysphagia, while those with the score of 6 or more were assigned to the group without dysphagia. The results of preoperative swallowing function, oral function, and geriatric assessment were compared between the groups using propensity score matching, with the factor of postoperative dysphagia as the covariate. It was found that oral function, Geriatric 8, comorbidity, cognitive function, nutrition, and falls were worse in the group with dysphagia. On the other hand, swallowing function and depression were worse in the group without dysphagia. The group with dysphagia performed poorly on tests related to sarcopenia, suggesting the usefulness of preoperative assessment of sarcopenia.